- Khi nghi ngd HC C.E.K phai cho benh nhan vao vien de theo doi hang gid Bat dong nep tam thd
8.GAY COT SONG DOAN NGUC-THAT LUNG •
Bi gay doan nay phan nhieu sau nga cao, do vat nang de vao ltfng... Doan cot song nay bao gom cac dot T i l T12 va L l, ndi co chop tuy gom nhieu doan tuy v i cac r l than kinh.
Thtfdng tdn hay gap nhat la dot song bi lun, xep. Ltfc gap cot song lam dot song bi lun xep d cot tru trtfdc. Cot tru gitfa va cot tru sau con lanh. Cau true day chang phia sau lanh.
Nhting benh nhan gay lun nay dtfdc xem la gay vting khi be cao dot song phia trtfdc xep dtfdi 50%, goc gu dtfdi 15°. Khong bi liet than kinh.
Cho benh nhan n im 1-3 ngay cho dd liet ruot roi lam theo cac cach sau: - Bo ao bot hay lap ao nep va cti dong sdm
- Tap cd nang theo M agnus: n&m nghi 1 tuan cti dong chan tay, sau do tap nghieng, lat ngtfdi sau 3 tuan tap di, sau do tap cac dong tac cui ngtfa than minh, tap doi nang dan v.v..
- Tap trong be bdi co ngtfdi htfdng d in Khi cot song bi gay khong vting, do la:
— Gay lun xep nang. Be cao dot song phia trtidc bi lun xep tren 50% — Gay than dot song co nhieu manh
— Gay trat
Tuy song co the khong bi liet
8.1. Keo nan
Benh nhan n&m sap, gay te vao canh ben cot song, song co the gay te vao qua gitia cac mom gai keo cot song th&ng theo true, xong keo cong Udn moi tu the keo 20 phut, xong bo ao bot, de bot 3 thang.
8.2. Mo nan, giai ep, co djnh trong vdi nep vit
8.2.1. Khi b j liet khong hoan toan
Sau gay nang cot song, can kham ky, co" tim mot dau vet cua ph&n khong bi liet nhu mot dau ngon chan con nhuc nhlch theo yeu cau, mot bo cd con ndi han, 1 ndi con cam giac. Doi vdi liet tuy khong hoan toan can rat tich ctfc de ctiu van tuy: n3n cap ctiu, md cap ctiu v.v..
Cung nhti b doan tuy co, co cac chi dinh sau day can md cap ctiu: 1. X quang cho thay 1 manh xtidng rdi chen vao ong tuy
2. Co trat dot song, nan khong vao thtfdng do gay trat mom khdp gai nhau. 3. Dau hieu liet than kinh tang len, thtfdng do mau tu ngoai m ang cting chen vao tuy.
4. T ic khoang dtfdi nhen, khong cho ltiu thong dich nao tuy, phat hien qua nghiem phap Queckensteat.
Khi md, gd cho gai nhau, nan thang cot song md manh ben, co dinh vdi nep vit qua cac cuong dot song. Co dinh 1 dot tren va 1 dot dtfdi cho gay.
Thai do dieu tri tich ctfc den vdi liet tuy khong hoan toan thtfdng co ket qua: liet tuy dUdc hoi phuc it ra la dtfdc 1 do Frankel, nhieu ca hoi phuc hoan toan.
Co le on g tuy dtfdc stia chtia trong qua trinh lien xUdng chting 50% xtfdng choi ra sau dtfdc tieu di vdi thdi gian.
8.2.2. Khi bj liet hoan toan
Chan doan sdm liet hoan toan co kho khan. Vi co tinh trang soc tuy trong 24 gid dau, che md het cac trieu chtfng. Khi het soc tuy, neu kham kl, khong con mot ti dau hieu gi cua cti dong theo y muon hay cua cam giac thi do la liet tuy hoan toan.
Cho den nay, chtfa co 1 trtfdng hdp nao bi liet tuy hoan toan ma co dtfdc hoi phuc. Nhtf vay viec cham soc y te nh&m vao cac muc tieu sau:
Chong loet: tran trd benh nhan moi 2 gid 1 lan cho nam sap. Cho nam gitfdng chong loet vdi cac dem hdi bdm xa thay doi, vdi gitfdng co dong cd thay doi cac ttf the, giti kho, xoa n&n vung bi chen ep b sau mong, d ba vai.
T inh trang lo6t co lien quan vdi thtfdng tdn tuy, tuy bi dtit ngang, loet ron g va sau.
San soc bi dai. Sau liet tuy, benh nhan bi bi dai can:
— Khuyen khigh benh nhan uong nhieu ntfdc, de dai dtfdc tren 1,5 lit moi ngay.
+ Thong dai moi 12 gid, vcd thong Nelaton. theo nguyen tac vo khuan thong thUdng. + Dat ong Fooley cap lai xa ong moi 6 gid. Thay ong Fooley moi 7 ngay.
Tranh bi bang quang be do lien tuc bi xep.
+ Bat dac di vi du bi viem qua nang mdi dan luu bang quang. - Sau thdi ky bi dai, khong can dat thong dai ntia.
Benh nhan tu dai dtfdc theo 2 kieu: (adsbygoogle = window.adsbygoogle || []).push({});
1. Bang quang tu dong: Do la sau thUdng ton cot song bi liet tuy ma ndi ton thtfdng cao hdn trung tam dieu khien di dai, la trung tam Budge nam d doan tuy cung S2,3,4. Ntfdc tieu thoat ra ttf dong nhd cung phan xa gay co bop bang quang. Khi m uon "di dai" benh nhan tao kich thich bang cach gai d mat trong dui hay go nhe len vung bang quang. Kich thich truyen len trung tam Budge, trung tam phat dau hieu den bang quang, co bop tong ntfdc tieu ra ngoai. Di dai ttfdng ddi theo y m uon, song co khi dai dam ra quan ao.
2. Bang quang ttf chu: Khi bang quang cang, benh nhan l i y tay an len b in g quang, ap ltfc ntfdc tieu tac dong len cac trung tam than kinh nam d vach b in g quang, lam bang quang co bop. Cd that md ra, dai dtfdc kieu di dai nay xay ra khi bi thtfdng tdn tuy thap, pha hong m i't trung tam Budge d chop tuy.
Kieu dai nay khong bi dam de, benh nhan tfng y hdn. Co y kien la nen pha huy trung tam Budge de co kieu dai theo bang quang tu chu thi tien hdn.
Trong thang d lu , khi bi bi dai thi benh nhan con c in nam vien de giai quyet viec bi dai. Khi da tu dai dtfdc thi benh nhan ve vdi xa hoi va gia dinh.
De de phong tao soi tiet nieu (thUdng soi Oxalat) benh nhan c i n kieng cac thtic an uong co nhieu Oxalat nhtf rau den do, dau phu, k ien g uong tra dac. kieng ca khoai tay.
C) cong dong, benh nhan dtfdc phuc hoi chtfc nang ve sinh due, ve van dong, dtfdc day nghe v.v..
Bien chting tiet nieu la nguyen nhan chinh gay ttf vong.
3. San soc bi ia. Trong thang dau bi bi ia, c i n an cac thtic an nhuan trang va ngtfdi cham soc mang gang moc phan.
Het chtfng 1 thang, benh nhan dai tien khong ttf chu. Co the tao thoi quen dai tien dung gid vi du sau btia an sang.